Abstract
Background
Ventral hernia repair is one of the most common operations performed worldwide, and
using mesh is standard of care to decrease recurrence. Biologic meshes are increasingly
used to minimize complications associated with synthetic mesh, but with significantly
higher cost and unclear efficacy. Until recently, most of the evidence supporting
the use of biologic meshes was from retrospective cohorts with high heterogeneity
and risk of bias. We aimed to report a meta-analysis of randomized controlled trials
comparing the outcomes of synthetic and biologic mesh in elective open ventral hernia
repair.
Methods
A literature search of PubMed, Embase, and Cochrane Library databases was performed
to identify randomized controlled trials comparing biologic and synthetic mesh in
elective open ventral hernia repairs. The postoperative outcomes were assessed by
means of pooled analysis and meta-analysis. Statistical analysis was performed using
RevMan 5.4. Heterogeneity was assessed with I2 statistics.
Results
A total of 1,090 studies were screened, and 22 were fully reviewed. Four randomized
controlled trials and 632 patients were included in the meta-analysis. Fifty-eight
percent of patients had contaminated wounds (Wound Classification II–IV). Hernia recurrence
(odds ratio 2.75; 95% confidence interval 1.76–4.31; P < .00001; I2 = 0%) and surgical site infections (odds ratio 1.53; 95% confidence interval 1.02–2.29;
P = .04; I2 = 0%) were significantly more common in patients with biologic mesh. The rates of
seroma, hematoma, and mesh removal were similar in both groups.
Conclusion
As compared to synthetic mesh, biologic meshes resulted in increased hernia recurrences
and surgical site infections. Current evidence supports macroporous, uncoated synthetic
mesh as the implant of choice for elective open ventral hernia repair, and its use
should be considered even in contaminated cases.
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Article info
Publication history
Published online: January 07, 2023
Accepted:
December 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
